dr. parker harleys & handshakes - acep now...to stop by. sign up for a ident-elect by the acep...
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BOSTON, MASSACHUSETTS • OCTOBER 26-29, 2015 • WWW.ACEP.ORG/ACEP15
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TUESDAY ISSUE
BACK AND FORTH
ACEP15 WHEELS
BE IMMORTAL! DONATE A BRICK AND HELP EMF “PAVE THE WAY” FOR THE FUTURE OF EMDonate a brick at ACEP’s new headquarters, and “Pave the Way” for the future of emergency medicine. Ensure that emergency medicine research always has a home in ACEP’s new building—and leave your mark on the specialty forever—by donating to the EMF Plaza, a beautiful collection of personalized brick pavers. Pricing and benefits are available from 7:30 a.m. to 5:30 p.m. Monday through Wednesday near the EMF Silent Auction in the North Lobby of the Boston Convention and Exhibition Center (BCEC).
emCareers.org LIVE DEBUTS AT ACEP15Calling all job seekers! New for Boston, the emCareers.org LIVE booth is located in the Northeast Lobby, Level 1 of the Boston Conven-tion and Exhibition Center. It is open Tuesday and Wednesday from 8 a.m. to 4 p.m—be sure to stop by. Sign up for a free CV consultation, receive personalized expert advice on how to make your CV shine, learn what employers are looking for, and craft a CV that highlights all of your skills and expertise. The official job bank of ACEP and EMRA, em-Careers.org has a fresh look and feel for ACEP15: • Find nearly 1,000 EM openings. • Register for job alerts to take control of your
job search. Be sure to register on-site for a chance to win one of three $100 American Express gift cards!
• Search career-development resources.
HOTEL SHUTTLE SCHEDULE: TUESDAY, OCT. 27DIRECTION HOURS FREQUENCY
To BCEC 7–11 a.m. Every 15–20 minutes
From BCEC 4–6:15 p.m. Every 20 minutes
Silver Line Train Service Only (no shuttle)
• Embassy Suites Boston at Logan Airport
• Hilton Boston Logan Airport
Walking Distance of BCEC (no shuttle)
• Westin Boston Waterfront • Seaport Boston Hotel • Residence Inn Boston Downtown/Seaport • Renaissance Boston Waterfront Hotel
Hotel-Provided Shuttle Service
• Hampton Inn & Suites Boston Crosstown Center
• The Liberty Hotel
HOTELS WITH NO ACEP SHUTTLE SERVICE
*NOT ACTUAL SHUTTLE
HOT SESSIONS
GETTING A BETTER HANDLE
ON ATRIAL FIBRILLATION
TREATMENTAND MORE CAN’T MISS SESSIONS
SEE PAGE 14
Illinois Emergency Physician Rebecca Parker Chosen as 2015–2016 ACEP President-ElectBOSTON—Rebecca Parker, MD, FACEP, the Chair of ACEP’s Board of Directors from Urbana, Illinois, was named Pres-ident-Elect by the ACEP Council during its meeting Sunday.
Dr. Parker is an attending emergen-cy physician with Centegra Health System in McHenry and Woodstock, Il-linois, and Presence Covenant Medical Center in Urbana,
Illinois. She is vice president at Em-Care North Division and president of Team Parker LLC, a consulting group. Dr. Parker is also clinical assistant pro-fessor at the Texas Tech El Paso depart-ment of emergency medicine.
“The only way we can practice the medicine we want is to create the prac-tice we want,” said Dr. Parker. “We will
CONTINUED on page 3
Dr. ParkerOPENING SESSION
Harleys & Handshakes
BOSTON—You’ve got to be present to win. Well, emergency physician Jennifer L’Hommedieu Stankus, MD,
JD, FACEP, was front and center at the opening session of ACEP15, and it won her a trip to the stage, courtesy of ACEP15 Opening Session speaker, motivational speaker Mark Scharenbroich.
Equal parts comedian and preacher, Mr. Scharenbroich and his wife run a company called Nice Bike, an homage to two words that connect any strangers, as long as one of them owns a motorcycle. He learned the words’ power at a gathering in Milwaukee in 2003 for Harley Davidson’s 100th anniversary and has since used them as a metaphor for how people connect.
CONTINUED on page 3
ACEP15 Opening Session speaker urges emergency physicians to
be present, focus on the good, and make personal connections
by RICHARD QUINN
A Complimentary Lunch Will Be Served
Acute Treatment of AgitationAssociated with Schizophrenia or Bipolar I Disorder
Boston Convention & Exhibition CenterExhibit Hall – Product Showcase II
Boston, Massachusetts
Scott L. Zeller, MDChief of Psychiatric Emergency Services
Alameda Health System
Oakland, California
TUESDAYOCTOBER 27, 201511:30 AM – 12:15 PM
PROGRAM DESCRIPTION: Provide an overview of the prevalence and burden of agitation
associated with schizophrenia or bipolar l disorder
Identify unmet needs in the acute management of agitation associated with schizophrenia or bipolar l disorder
Discuss currently available therapies for patients presenting with agitation associated with schizophrenia or bipolar l disorder
Describe the pharmacology, ef� cacy, and safety of an acute treatment option for agitation associated with schizophrenia or bipolar l disorder in adults
Please join us for a Product Showcase Lunch Presentation at the ACEP15 Scientifi c Assembly
If you are licensed in any state or other jurisdiction or are an employee or contractor of any organization or governmental entity that limits or prohibits meals from pharmaceutical companies, please identify yourself so that you (and we) are able to comply with such requirements. Your name, the value, and purpose of any educational item, meal, or other items of value you received may be reported as required by state or federal law. Once reported, this information may be publicly accessible. Thank you for your cooperation.
This is a promotional event. CME/CE credit will not be available for this session.
In compliance with PhRMA guidelines, spouses or other guests are not permittedto attend company-sponsored programs. This promotional activity is brought to you by Teva Select Brands and is not certi� ed for continuing medical education. The speakers are presenting on behalf of Teva Select Brands and must present information in compliance with FDA requirements applicable to Teva Select Brands.
© 2015, Teva Pharmaceuticals USA, Inc.February 2015 TSB-40136
WWW.ACEP.ORG/ACEP15
OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS TUESDAY ISSUE 3
EDITORIAL STAFFEDITOR
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ART DIRECTOR Paul Juestrich
PHOTOGRAPHY Matt Hichborn
MANAGER, DIGITAL MEDIA AND STRATEGY
Jason [email protected]
ACEP STAFFEXECUTIVE DIRECTOR
Dean Wilkerson, JD, MBA, [email protected]
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Robert Heard, MBA, [email protected]
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PUBLISHERLisa Dionne
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(781) 388-8548
CLASSIFIED ADVERTISING Kevin Dunn
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INFORMATION FOR SUBSCRIBERS
ACEP15 Daily News is published on behalf of the American College of Emergency Physicians by Wiley Subscription Services, Inc., a Wiley Company, 111 River Street, Hoboken, NJ 07030-5774. Printed in the United States by TriStar Publishing Inc., Overland Park, KS. Copyright © 2015 American College of Emergency Physicians. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means and without the prior permission in writing from the copyright holder. The ideas and opinions expressed in ACEP15 Daily News do not necessarily reflect those of the American College of Emergency Physicians or the Publisher. The American College of Emergency Physicians and Wiley will not assume responsibil-ity for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. The views and opinions expressed do not necessarily reflect those of the Publisher, the American College of the Emergency Physicians, or the Editors, neither does the publication of advertisements constitute any endorsement by the Publisher, the American College of the Emergency Physicians, or the Editors of the products advertised.
OPENING SESSION | CONTINUED FROM PAGE 1
ACEP PRESIDENT-ELECT | CONTINUED FROM PAGE 1
On Monday morning, he brought the power of that message to hundreds of emergency phy-sicians here—and for Dr. Stankus, the proud owner of a black Softail Slim, he made it per-sonal. He used her work at Tacoma General Hospital and Madigan Army Medical Center, both in the Tacoma, Washington, area, to thank all emergency physicians.
“Thank you for saving lives,” he said. “Thank you for dedicating your brilliance to the lives of others. Thank you for embracing each and every single day. You are absolutely amazing. And for that, I say to you, ‘Nice bike.’”
Scharenbroich then suggested Dr. Stankus and all the attendees acknowledge—“be fully present with others.” He urged them to hon-or—“create remarkable experiences for oth-ers.” And he pushed them to connect—“make it personal.”
Perhaps most important? “You’ve got to be present to win,” he said.That last tenet resonated with Dr. Stankus.“You have to be in the moment and put your
phone down,” she said. “Put other distractions aside and focus on the person and what you’re doing. It’s super-important. It’s a skill that we [as emergency physicians] acquire and culti-vate and master. It’s what makes us good.”
Good was the idea of the morning. Be good to others. Focus on the good of the mo-ment. Mr. Scharenbroich, through anecdotes, analogies, and affability, told of the goodness that fraternity and fellowship—of the non-medical variety—can bring to life, in the ED and out of it.
“My great hope for you is that with every single patient, every single colleague you have, that you’re…present in their lives, that you cre-ate that remarkable experience of listening to the music of the heart,” he said. “And that you make it personal for them.”
Said another way? Nice bike.
RICHARD QUINN is a freelance writer in New Jersey.
never stop fighting for the right of emergency physicians to deliver high quality care and to receive fair and just payment for that care. We know emergency medicine better than any health plan or insurance company.
“We have to take the lead in establishing standards and never back down from fighting for the right to have resources to provide the lifesaving care we deliver every day, every shift,” she added.
Dr. Parker has been ac-tive with ACEP for about 20 years. She has been a member of both ACEP’s Texas and Il-linois Board of Directors and chaired both chapters’ Educa-tion Committees. She served in a variety of leadership po-sitions on the Illinois ACEP Board, including President-elect when she was elected to the national ACEP Board of Directors for the first time in 2009.
For national ACEP, Dr. Parker’s service in-cludes work on the EM Practice Committee, Reimbursement Committee, Chapter Rela-tions Committee, Finance Committee, and the
editorial board of Vital Care. Dr. Parker has re-ceived awards for her leadership roles, includ-ing the AMA’s Foundation Leadership Award and the AMA’s Women’s Physician Congress Mentor Award.
Dr. Parker was elected to ACEP’s Board of Directors in 2009 and 2012. She earned her medical degree at Northwestern University Medical School in Chicago and completed her internship and residency at Texas Tech Univer-sity Health Sciences Center in El Paso.
Dr. Parker will assume ACEP’s presidency at next year’s Council Meeting in Las Vegas.
“The only way we can practice the medicine we want is to create the practice we want. We will never stop fighting for the right of emergency physicians to deliver high quality care and to receive fair and just payment for that care. We know emergency medicine better than any health plan or insurance company.”—Rebecca Parker, MD, FACEP
ACEP15 attendees packed the grand ballroom to hear Opening Session speaker Mark Scharenbroich.
WWW.ACEP.ORG/ACEP15
4 TUESDAY ISSUE OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS
As part of its ongoing commitment to providing the highest quality of emergency care, ACEP has developed the Clinical Emergency Data Registry, or CEDR. This is the first emergency medicine specialty-
wide registry to support emergency physicians’ efforts to improve quality and practice in all types
of EDs, even as practice and payment policies change over the coming years. The ACEP CEDR has been approved by CMS as a qualified clinical data registry. The CEDR will provide a unified method for ACEP members to collect and submit Physician Quality Reporting System data, Maintenance of
Certification, Ongoing Professional Practice Evaluation, and other local and national quality initiatives. Get more information, watch demonstra-tions, and sign up on site 8 a.m.–4 p.m.,Monday through Wednesday, in the North Lobby of Level 1 of the BCEC.
Improve Quality With ACEP’s Clinical Emergency Data Registry
AL SACCHETTI, MD, FACEP, has spent 35 years working in emergency departments, and in all that time, he doesn’t think he’s met a doctor or a nurse without a sense of humor. He will share his insights at the James D. Mills Jr. Memorial Lecture at 10 a.m. on Tuesday, Oct. 27. In the session, “Lessons My Patients Have Taught Me: Humor, Humility, and Hu-manity Learned at the Bedside,” Dr. Sacchetti hopes to show how physicians need to tai-lor their approach to the patient and not just take a uniform tack with everyone. But most of all, Dr. Sacchetti will tell the story of an emergency physician thrilled with the career choice he made.
“It’s very clear that this is the only specialty where you can see every aspect of human life, and you can do it in a 12-hour shift,” he said. “There is no other area of medicine where you can see everything from a newborn to a cente-
MILLS LECTURE
Add Humor to Your Bag of Medical Tricks at Today’s Mills Lecture
narian … you get to see stuff that no other spe-cialty gets to experience. And you do it pretty much on a daily basis.”
RICHARD QUINN is a freelance writer in New Jersey.
by RICHARD QUINN
Dr. Sacchetti
LESSONS MY PATIENTS HAVE TAUGHT ME: HUMOR, HUMILITY AND HUMANITY LEARNED AT THE BEDSIDETuesday, Oct. 2710 am–10:50 a.m.Room 253 ABC
DON’T MISS THESE EMF EVENTSTHE EMERGENCY MEDICINE FOUNDATION (EMF) invests its funds to further emergency medicine research and education. To date, EMF has awarded more than $12 million in research grants to advance emergency medicine, science, and health policy. EMF’s mission is to promote education and research that develops career emergency medicine researchers, improves patient care, and provides the basis for effective health policy. Because of its generous donors, EMF awards more than $600,000 in emergency medicine grants each year.
EMF Grantee Reunion Reception (by invitation only)
Meet other EMF research grantees who have benefitted from EMF funding and hear stories of how their research is making a difference in emergency medicine. New this year, the EMF Grantee Reunion Reception will take place from 4:30 to 5:30 p.m. Tuesday, Oct. 27 in Room 256 at the BCEC.
EMF Major Donor Lounge (by invitation only)
EMF donors who have given $500 or more since Jan. 1, 2015, and Wiegenstein Legacy Society members are invited to this relaxed setting offering breakfast, lunch, and snacks; a computer; a printer; and charging stations. Stop by Room 256 in the BCEC from 7:30 a.m. to 4 p.m. Tuesday and Wednesday.
EMF Silent AuctionThe popular favorite souvenir shop returns to ACEP15. Stop by the EMF Silent Auction for a chance to bid on hundreds of items, with proceeds benefitting EMF. Items include sports, music, and celebrity memorabilia; jew-elry; artwork; vacation getaway packages donated by members; and more! Managed by All Star Enterprises, the EMF Silent Auction is open from 7:30 a.m. to 5:30 p.m. Tuesday and Wednesday in the North Lobby of the BCEC.
MAXIMIZE YOUR EXPERIENCE!It’s available in the Apple App Store and the Google Play store. Get schedules, syllabi,
and surveys. Use your login credentials from your ACEP15 registration.
USE THE ACEP15 MOBILE APP
WORK HARD AND PLAY HARD WITH EMRA THE EMERGENCY MEDICINE RESIDENTS ASSOCIATION (EMRA) ACTIVITIES TODAY START WITH A LECTURE COMPETITION, FOLLOWED BY A LEGENDARY PARTY. EMRA EVENTS COME AT NO CHARGE TO RESIDENTS AND MEDICAL STUDENTS. HERE IS TODAY’S LINEUP:
TUESDAY, OCT. 27
20 in 6: EMRA Resident Lecture Competition4–6 p.m.Sponsored by EM:RAP
Watch your fellow residents vie for the title of best resident lecturer when each competitor gives 20 slides in six minutes on any topic.
The EMRA Party at ICON and VEN10 p.m.–2 a.m.Sponsored by Emergency Medical Associates
EMRA brings you two adjoining nightclubs in one exciting evening!
In addition to the sponsors listed in Monday's ACEP15 Daily News, St. Joseph’s Regional Medical Center sponsored the EMRA Medical Student Luncheon.
WWW.ACEP.ORG/ACEP15
OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS TUESDAY ISSUE 5
DON’T BE CAMERA SHY—COME ON BY!
Get your picture taken by a professional photographer, and we’ll send you the finished digital headshot after the conven-tion, absolutely free. Use it for your Linke-dIn page, Facebook profile, or however you would like. While you’re there, please help ACEP with some promotional im-ages. If you’ve seen some of your colleagues in our advertisements or conference promotions throughout
the year, it’s because they stopped by the studio and spent a couple of minutes with our marketing team. While you’re there, please give us a video testimonial as well. What’s on your mind? What’s your favorite ACEP member benefit? What do you love about emergency
medicine? Say it for the camera. We very much appreciate the help!
STUDIO ACEP OPENS TUESDAY AT 9:30 A.M. JUST OUTSIDE THE REGISTRATION AREA AT THE BOSTON CONVENTION AND EXHIBITION CENTER AND DOESN’T SHUT DOWN UNTIL THE CAMERA CALLS IT QUITS AT 5 P.M.
038851-150818
Sponsored by Janssen Pharmaceuticals, Inc.
TUESDAY, OCTOBER 27, 201511:30 AM – 12:15 PMSeating available on a � rst-come, � rst-served basis.
BOSTON CONVENTION & EXHIBITION CENTERExhibit Hall - Product Showcase 1Boston, Massachusetts
STANLEY C. THOMPSON, MDRegional Medical DirectorTEAMHealth MidsouthMemphis, Tennessee
PROGRAM DESCRIPTION
This lecture will present options for reducing the risk of stroke in patients with nonvalvular atrial � brillation.
ACTIVITY DISCLOSURE
In adherence with PhRMA guidelines, spouses or other guests are not permitted to attend company-sponsored programs.
For all attendees, please be advised that information such as your name and the value and purpose of any educational item, meal, or other items of value you receive may be publicly disclosed. If you are licensed in any state or other jurisdiction, or are an employee or contractor of any organization or governmental entity that limits or prohibits meals from pharmaceutical companies, please identify yourself so that you (and we) are able to comply with such requirements.
Please note that the company prohibits the offering of gifts, gratuities, or meals to federal government employees/of� cials. Thank you for your cooperation.
This promotional educational activity is not accredited. The program content is developed by Janssen Pharmaceuticals, Inc. Speakers present on behalf of the company and are required to present information in compliance with FDA requirements for communications about its medicines.
The personal information you provided when registering for the conference may be used to contact you about your attendance at this Presentation, supported by Janssen Pharmaceuticals, Inc. This information may be shared with Janssen Pharmaceuticals, Inc., its af� liates, and a third party for the sole purpose of completing your registration for this program and as required by law.
This symposium is not a part of the of� cial Scienti� c Assembly educational program as planned by ACEP’s Educational Meetings Committee.
© Janssen Pharmaceuticals, Inc. 2015 October 2015
PLEASE JOIN US FOR A PRODUCT SHOWCASE LUNCH PRESENTATION AT THE ACEP15 SCIENTIFIC ASSEMBLY
IMPROVING CLINICAL PRACTICE IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION
by JEREMY FAUST, MD, MS
I t’s Day 1 at the ACEP annual meeting and if you have Twitter, your phone is prob-ably blowing up with #ACEP15 news and
a mountain of great educational pearls. If you don’t have Twitter but want to know
what is happening in every room of this mega-conference other than the one you’re currently in, here’s a quick round up of top tweets from some of the most influential emergency medi-cine tweeters at this year’s annual meeting.
In just the first few hours of the confer-ence, well over 4,000 tweets were posted. (It still boggles my mind that in 2012, fewer than 1,500 tweets were posted the entire week!)
This year, Drs. Rick Bukata and Jerry Hoff-man continued their annual popular session “Clinical Pearls From the Recent Medical Lit-erature.” Dr. Salim Rezaie (@srrezaie) tweeted a key take-home message from one study they featured (Kanzaria HK, Hoffman JR, Probst MA, et al. Emergency physician perceptions of medically unnecessary advanced diagnostic imaging. Acad Emerg Med. 2015;22:390-398.). “Why do EM Docs Order Unnecessary Tests? Top 2 Reasons: 1. Don’t Want to Miss Dx 2. Don’t Want to Get Sued.”
Interestingly enough, Jerry and Rick threw some complexity on the picture, citing a New England Journal of Medicine paper (Waxman DA, Greenberg MD, Ridgely MS. The effect of malpractice reform on emergency department care. N Engl J Med. 2014;371:1518-1525), that sur-prisingly found that litigation reform did not change rates of advanced imaging or hospital admission in three states. And in case you’re wondering, yes, the hashtag #Hofkata seems to have survived from 2014.
Dr. David Callaway’s session “That Wasn’t a Firecracker: There’s an Active Shooter in the Hospital” was a harrowing talk on an im-portant topic we all wish were not necessary. Sad but true, but this situation is more likely than an Ebola exposure. From Dr. Sean Fox (@PedEMMorsels): “Metal detectors in the ED de-crease the number of weapons, but [do] not de-crease number of assaults.” Finally, winning the award for Twitter-pearl-I-hope-none-of-us-ever-has-to-see, from @HenryFordEM: “Active shooter lecture: great door barricade is stretch-er pushed up against door and wheels locked.”
Here’s to a safe and educational #ACEP15! For more daily round-ups, check out FOAMcast on iTunes or at FOAMcast.org with me, and my cohost Dr. Lauren Westafer (@LWestafer).
Special thanks to the #ACEP15 official so-cial media team and everyone else tweeting from Boston.
DR. FAUST is an emergency medicine resident at Mount Sinai Hospital in New York and Elmhurst Hospital Center in Queens.
START A #ACEP15 TREND
WWW.ACEP.ORG/ACEP15
6 TUESDAY ISSUE OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS
TAKE ADVANTAGE OF THE NEMPAC DONOR LOUNGEBecause of ACEP member support, the National Emergency Medicine Political Action Com-mittee (NEMPAC) has become one of the top medical PACs in the country and a respected political voice in Washington, D.C. ACEP15 is your opportunity to not only participate in the annual giving campaign, but to learn more about NEMPAC’s year-round activities. Which candidates will NEMPAC back in coming elec-tions and why? What are the most important items on the legislative agenda? NEMPAC leaders and staff will be on hand to answer your questions. Learn more about NEMPAC when you get to Boston and get involved.
NEMPAC VIP Donor Lounge (by invitation only)
TUESDAY, OCT. 27– WEDNESDAY, OCT. 288 a.m.–4 p.m.ACEP members who have do-nated $600 or more in the past year are invited to relax in this private lounge with complimentary breakfast, lunch, snacks, profes-sional neck and shoulder mas-sages, television, and business center amenities. NEMPAC Board members and staff will be on hand to discuss NEMPAC’s activities and agenda.
WATCH THESE 10-MINUTE PRESEN-TATIONS IN THE ED TALKS THOUGHT LEADER THEATER to discover how these cutting-edge products and services drive change in your emergency department. Catch it all at innovatED in the Exhibit Hall at Boston Convention and Exhibition Center.
TUESDAY11:10–11:20 a.m. Three Ingredients for LettingDoctors Be DoctorsPresented by Todd Rothenhaus, MD, chief medical officer and senior vice president of network knowledge, athenahealth,Watertown, MassachusettsThanks to a combination of bad technology, changing reimbursements, and piles of regula-tions, it's harder now than ever for doctors to do what they were trained for: treating patients. But all hope is not lost, argues Dr.Rothenhaus. By combining a better user experience, more relevant patient information and connectivity, and realtime decision sup-port within the workflow, it is possible to once again let doctors be doctors.Sponsored by athenahealth
11:50 a.m.–noon Defusing the Threat: A Multidisciplinary Approach to the Management ofCombative Patients in the ED
Presented by Lynn Roppolo, MD, FACEP, associate professor of emergency medicine and associate director of the emergency medicine residency program, University of Texas Southwestern Medical Center, Dallas
Learn new strategies designed to decrease the number of physical assaults on medical staff by aggressive patients in the ED.Sponsored by Critical Decisions
2:40–2:50 p.m. LMA Protector—New Possibilities inEmergency Airway ManagementPresented by Stephen R. Luney, MB BCh BAO, consultant neuroanesthetist, Royal Group of Hospitals, Belfast, U.K.
This presentation will explore the potential of the LMA Protector to separate the digestive and respiratory tracts in the context of emergency airway management. Sponsored by Teleflex Inc.
Don’t Miss These ED Talks
Prep for DiscomfortCritical neurological conditions that fall outside the EM comfort zone
BOSTON—BAO and PRES and colloid cysts, oh my.
Matthew Siket, MD, co-director of the stroke centers at Rhode Island and The Miriam hospi-tals in Providence, didn’t want to sound like a fear monger when he delivered “Case Studies of Subtle Presentations of Devastating Neuro-logical Conditions” at ACEP15 on Monday af-ternoon. But he most assuredly wanted the emergency physicians who gathered—and those reading this now—to view the session as a clarion call that taking an extra minute to be vigilant for worst-case scenarios is important.
“It’s increasing awareness that these enti-ties exist, that they can be emergent, and hav-ing it in your diagnostic armamentarium can help you be a better clinician,” said Dr. Siket, assistant professor of emergency medicine at The Warren Alpert Medical School of Brown University in Providence.
Via a series of case studies, Dr. Siket intro-duced less common medical conditions such as BAO (basilar artery occlusion), PRES (pos-terior reversible encephalopathy syndrome), and CADASIL (cerebral autosomal-dominant arteriopathy with subcortical infarcts and leu-koencephalopathy). He doesn’t expect emer-gency physicians to become neurologists, but
rather to be aware of the conditions and be pre-pared should one present.
In fact, Dr. Siket believes that ACEP15 and other large-scale educational opportunities are a perfect place to learn about concepts, conditions, and care normally outside doc-tors’ proverbial comfort zones.
“We need to use forums like this to dis-cuss the things we don’t see as often,” he said. “Maybe identify the areas that we’re a little less comfortable clinically. Our perceived weak-nesses. The patients we’re not excited to see. For a lot of us, the subtle or obscure neuro-logical condition is entirely the opposite of emergency medicine. It’s the field we chose not to go in. But it’s very relevant.”
Kerin Howe, ARNP, agrees. “I’m not well educated on subtle neurological conditions,” said Ms. Howe, who works for Florida Emer-gency Physicians in Orlando. “You hear this
and it’s an eye opener.” Ms. Howe will now add the presentations to
her differential as she sees neurological cases back home. So will Robert Butler, MD, a fourth-year medical student at Brown University in Providence.
“A lot of times…you have someone who you just have a extra sense about,” said Dr. Butler, who has worked under Dr. Siket as an attend-ing. “This talk, it moves your discussion to a higher level. You think, ‘What about PRES? What about something else?’ It might just push [you] a little bit farther to get the MRI or do another test. I’m more comfortable thinking about it after seeing this and [more comfort-able] having that discussion with neurologists and neurosurgeons.”
RICHARD QUINN is a freelance writer in New Jersey.
by RICHARD QUINN
WWW.ACEP.ORG/ACEP15
OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS TUESDAY ISSUE 7
ACEP15 Attendees Invited to Attend AMA Roundtable Steven J. Stack, MD, FACEP, the current AMA President—the first emergency physician to ever hold that position—is the featured speaker at today’s AMA Roundtable. The Roundtable will take place noon Tuesday in Room 209 at the BCEC. Lunch will be provided and all physi-cians and medical students are invited to attend.
“Tube Stealer” Advocates for Non-Invasive Positive Pressure The first step, says Scott Weingart, MD, is to obtain and learn how to use a ‘decent’ ventilator
BOSTON—Many may know Scott D. Wein-gart, MD, FACEP, as the chief of the Division of Emergency Critical Care at Stony Brook Hospi-tal in New York City, and clinical associate pro-fessor of emergency medicine at Stony Brook Medicine. However, his coworkers often refer him to as “The Tube Stealer,” for advocating noninvasive positive pressure (NIPP) ventila-tion in specific patients. The advantages are clear, he said, including the elimination of crash intubations and reduced ICU stays.
For emergency physicians who wish to join Dr. Weingart’s camp, he suggested preparing for these patients by, first, acquiring a decent non-invasive or standard ventilator and learn-ing to use it.
“We always get the crappiest ventilators in the ED,” he told a jam-packed room at ACEP15.
“Fight to get a good one.” If that is impossi-ble, he recommended investing in stand-alone continuous positive airway pressure (CPAP) devices that hook up to wall oxygen, at a cost of approximately $30 for a single-use package that includes a mask.
Although modern ventilators look com-plex, Dr. Weingart said that there are only a few dials that an emergency physician needs to know. First, set the mode to “spontaneous.” “This way, the patient has to inhale to get a breath,” he said. “Leave [the trigger] to what-ever it’s already set to.”
The key is to understand the use of posi-tive end expiratory pressure and type of ex-halation. Inspiratory positive airway pressure (IPAP) fixes ventilation issues. Expiratory pos-itive airway pressure (EPAP) fixes oxygenation problems. “Don’t give IPAP if ventilation is fine. Don’t give EPAP if oxygenation is fine,”
by TERESA MCCALLION Dr. Weingart said, adding it’s important to re-member that an increase in EPAP causes the tidal volume to fall.
He also said he believes that, in these situa-tions, there is no difference between CPAP and bi-level positive airway pressure (BiPAP). The real question should be, how much expiratory pressure does the patient need?
With regard to patients in respiratory fail-ure, there are generally two types—those with an oxygen issue and those with chronic issues, including those with chronic obstruc-tive pulmonary disease (COPD), which are typically a ventilation problem.
“There is no better use of noninvasive ven-tilation than COPDers. This is the huge ‘win’ we have in the ED,” he said.
Another type of patient who can bene-fit from NIPP are those suffering from sym-pathetic crashing acute pulmonary edema
(SCAPE). Dr. Weingart said these patients present as pale, cold, and sweaty.
“If we don’t treat them immediately, they will die,” he said. He also noted that NIPP pro-vides a secondary benefit of reducing after-load. “It gives the heart a nice little squeeze.”Dr. Weingart also uses NIPP for patients in res-piratory distress with DNR orders.
“It seems like an aggressive modality, but it’s actually comfort palliation,” he said. If the family wants to be with them, he exchanges the non-rebreather mask for a high-flow, na-sal cannula.
According to Dr. Weingart, several patient populations benefit from the use of NIPP. Al-though he is known by his colleagues for steal-ing their tubes, he said,“That’s a good thing.”
TERESA MCCALLION is a freelance medical writer based in Washington State.
VOXDOX WINS TOP AWARD AT EM HACKATHON
TIME-SAVING INNOVATIONS for emergency departments took top honors at the second annual EM Hackathon, where physicians collaborated with computer programmers, engineers, and other experts to tackle challenges facing emergency medicine.
The CodeRed competition, which com-bined the efforts of ACEP, the Emergency Medicine Residents Association, Hacking Medicine at the Massachusetts Institute of Technology, and Grand Sponsor athenahealth, started early Friday evening and continued through early Sunday.
The winner of the $3,000 grand prize was a team called VOXDOX, which developed a system that integrates voice-activated software with electronic medical records to help physicians spend more time with their patients and less time with the computer.
THE OTHER PRIZE WINNERS WERE:• Best EM Solution ($2,000): Rapid ROS• EM Runner-up ($1,000): EM Compass• Best athena API Solution ($2,000): TrackBack • athena API Runner-up ($1,000): UpdatEDpatient• Two Honorable Mentions ($500 each): PharmaCube & FairMeds • EMRA Prize ($500): Lung or Gut we’ll save your butt!
Emergency physicians in Boston this week have many opportunities to learn about and support ACEP’s advocacy
agenda in preparation for a packed legislative agenda in Congress and the 2016 elections.
As in years past, ACEP Council members stepped up to the plate during the NEMPAC Council Challenge to ensure that emergency medicine stays at the top of the leaderboard among medical political action committees and continues to be a strong, respected voice in Washington, D.C.
Prior to and during the ACEP Council meet-ing Saturday and Sunday, NEMPAC collected nearly $300,000 from Council members. Com-bined with thousands of donations by ACEP members across the country this year, NEM-
PAC is well on the way to exceeding the $1 mil-lion goal set by the ACEP Board in 2015.
NEMPAC serves a vital role in advancing ACEP’s legislative agenda and in broadening ACEP’s visibility with Congress. This growth has allowed NEMPAC to be involved in hun-dreds of races across the country and help the re-election efforts of two ACEP members: Rep. Joe Heck (R-NV), who is running for Senate in Nevada, and Rep. Raul Ruiz (D-CA). NEMPAC and the USACS PAC co-hosted events for both legislators here in Boston.
NEMPAC is currently the fourth largest phy-sician specialty political action committee, be-hind anesthesiologists, orthopedic surgeons, and radiologists—with a goal of becoming number one. This goal has been embraced by
ACEP members as well as by emergency medi-cine group practices, which are finding crea-tive ways to encourage their ACEP member physicians to support NEMPAC.
This year, ACEP physicians in seven emer-gency medicine group practices were recog-nized for their outstanding support including: CEP America, EmCare, Emergency Medicine Physicians (EMP), Eastside Emergency Phy-sicians (EEP), Florida Emergency Physicians (FEP), Medical Emergency Professionals (MEP), and Wake Emergency Physicians (WEPPA).
911 Legislative Grassroots NetworkDuring the Council meeting, the Arizona, Michigan, North Carolina, and Texas ACEP
Chapters were recognized for their efforts to in-crease participation in the 911 Network, emer-gency medicines’ premier grassroots advocacy network. EMRA also received an award for go-ing the extra mile in engaging EM residents in legislative and political advocacy.
911 members establish relationships and serve as resources for federal legislators and their staffs. Dr. Arlo Weltge from Houston, TX was recognized this week as the 911 Network Member of the Year.
The Network currently has more than 2,000 participants and is looking to expand into every congressional district with the help of interested emergency physicians. For more information, please go to www.acepad-vocacy.org.
ACEP Advocacy in High Gear at ACEP15
WWW.ACEP.ORG/ACEP15
8 TUESDAY ISSUE OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS
PRODUCT AND SERVICE SHOWCASES KEEP YOU UP TO SPEEDThese educational and product-oriented sessions provide you with an in-depth presentation on a product or service you may have seen on the exhibit floor. Show up early! Seating is limited to 150, and a boxed meal will be served at each event. Attendees will be entered into a drawing to win a registration to ACEP16 in Las Vegas.
TUESDAY11:30 a.m.–12:15 p.m.Janssen Pharmaceuticals Product ShowcaseA Paradigm Shift in the Treatment of Thrombosis Product Showcase I, Exhibit Hall, BCEC
11:30 a.m.–12:15 p.m.Teva Pharmaceuticals Product ShowcaseAcute Treatment of Agitation Associated with Schizophrenia or Bipolar I DisorderProduct Showcase II, Exhibit Hall, BCEC
2:30–3:15 p.m.Mallinckrodt Pharmaceuticals Product ShowcaseOFIRMEV (acetaminophen) Injection: A Non-Opioid Foundation for Multimodal Analgesia in the Perioperative PatientProduct Showcase I, Exhibition Hall, BCEC
Albany Medical Center Emergency Physicians
All Childrens Emergency Center Physicians
APEX Emergency Group
Asheboro Emergency Physicians PA
Athens-Clarke Emergency Specialist
Augusta Emergency Physicians
Big Thompson Emergency Physicians PC
BlueWater Emergency Partners
Brooklyn Hospital Center Emergency Physicians
Cabarrus Emergency Medical Associates
Carson Tahoe Emergency Physicians
Cascade Emergency Associates
Cascade Emergency Physicians Incorporated
Catawba Valley Emergency Physicians- Wake Forest
Central Coast Emergency Physicians
Centre Emergency Medical Associates
Childrens Hospital at Oklahoma University Medical Center Section of Pediatric Emergency Medicine
Comprehensive Emergency Solutions, SC
Concord Emergency Medical Associates
Covenant Health Care
Department of Emergency Medicine South Alabama
Doctors Emergency Services Delaware
E Merge Physicians
East Carolina University
Eastside Emergency Physicians
Elkhart Emergency Physicians, Inc.
EM Medical PC
Emergency Associates of Yakima
Emergency Care Consultants PC
Emergency Care Specialist Incorporated
Emergency Medical Associates PLLC
Emergency Medical Associates SW Washington Medical Center
Emergency Medical Professionals, PA
Emergency Medical Specialists Colorado Springs
Emergency Medical Specialists PC
Emergency Medicine Associates Ltd
Emergency Medicine Associates Philippines Company
Emergency Medicine of Idaho
Emergency Medicine Specialists of Orange County
Emergency Physicians & Consultants
Emergency Physicians of Central Florida LLP
Emergency Physicians of Indianapolis
Emergency Physicians of Tidewater
Emergency Professional Services PC
Emergency Service Associates
Emergent Medical Associates
EmergiNet
Emerson Emergency Physicians LLC
Emory Department of Emergency Medicine
EPIC, LLC
First Contact Medical Specialist
Flagstaff Emergency Physicians
Florida Emergency Physicians Kang & Associates
Florida Regional Emergency Associates
FrontLine Emergency Care Specialist
Georgia Emergency Medical Specialist
Georgia Emergency Physician Specialists LLC
Georgia Regents University
Grand River Emergency Medical PLC
Green Country Emergency Physicians
Hawaii Emergency Physicians Associates Incorporated
Idaho Emergency Physicians PA
Indiana University Health Physicians
Johns Hopkins Medical Institute Faculty
Lehigh Valley Physicians Group
Long Island Emergency Medical Care PC
Long Island Jewish Emergency Physicians
Maine Medical Center Emergency Physicians
Medical Center Emergency Services
Medical Services of Prescott
MEP Health LLC
Mercy Hospital Emergency Physicians
Mercy Medical Center Emergency Medicine Physicians
Merrimack Valley Emergency Associates
Mid Atlantic Emergency Medical Associates
Midland Emergency Room Corporation PC
Napa Valley Emergency Medical Group
New York Methodist Hospital Emergency Physicians
Newport Emergency Medical Group Incorporated
Newport Emergency Physicians Incorporated
North Memorial Emergency Physicians
North Shore Forest Hills Emergency Physicians
North Shore Franklin Hospital
North Shore Huntington Hospital
North Shore LIJ Lennox Hill HealthPlex
North Shore Plainview Hospital
North Shore Southside Hospital
North Shore University Hospital at Syosset
North Shore University Hospital Emergency Physicians of Manhasset
North Shore University Hospital Glen Cove
North Sound Emergency Medicine
North West Iowa Emergency Physicians
Northeast Emergency Medicine Specialists
Northside Emergency Associates
Orion Emergency Services
Pacific Emergency Providers APC
Pediatric Emergency Medicine
Peninsula Emergency Physicians, Inc
Phoenix Physicians Services Incorporated
Physician Services of Kansas University
Preston MD & McMillin MD PC
Professional Emergency Physicians Incorporated
Puget Sound Physicians
Pullman Region Hospital
Questcare Medical Services
Rapid City Emergency Services PA
Rutgers Robert Wood Johnson Medical School Physicians
Sandhills Emergency Physicians
Sanford Emergency Department
Scottsdale Emergency Associates
Southwest Florida Emergency Physicians
St Joseph Hospital Bangor Maine
St Jude Emergency Medical Group Incorporated
St Paul Emergency Room Docs, PA
Sturdy Memorial Emergency Physicians
Tacoma Emergency Care Physicians
Tampa Bay Emergency Physicians
Timberline Emergency Physicians PC
Tri City Emergency Medical Group
Tufts Medical Center EP, LLC
UAB Emergency Medical
UF Department of Emergency Medicine Group
UMass Memorial Emergency Medicine
Unity Emergency Physicians PA
University of Florida Jacksonville
University of Louisville Physicians
University of Mississippi Medical Center Physicians
University of Virginia Physicians Group
University Puerto Rico
Wake Emergency Physicians PA
Washington University - Missouri
Wenatchee Emergency Physicians PC
West Virginia University Hospital
Western New Mexico Emergency Physicians
Westfield Emergency Physicians
Winter Haven Hospital
ACEP HONORS GROUPS IN THE 100% CLUBACEP’s Group Recognition Program is a great way to show your employees that you care about their continued success. This year, there are 136 groups in ACEP’s 100% Club. If your group is interested in participating in ACEP’s Group Recognition Program, please visit the ACEP15 registration area or the Resource Center inside the Exhibit Hall.ACEP proudly recognizes these groups that have all eligible emergency physicians enrolled as members:
WWW.ACEP.ORG/ACEP15
OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS TUESDAY ISSUE 9
Participate in Study at Research ForumPLANNING TO VISIT THE ACEP RESEARCH FORUM? If so, be sure to stop by the ACEP ICU! Sponsored by The Medicines Company, this new feature offers Research Forum attendees a unique simulated patient experience, along with the opportunity to participate in a cutting-edge study of normative practice patterns. Always looking forward, the ACEP Research Forum is your portal to what’s next in emergency medicine.
SCHEDULE
TUESDAY, OCT. 277 a.m.–3 p.m. Registration
7 a.m.–5 p.m. Abstracts open
8–9 a.m. Electronic Abstract Session IV
9–10 a.m. Oral Presentation III—Get Your Geek On!
Transforming Emergency Care with Technology
10–10:30 a.m. State-of-the Art: Books, Blogs and The Diamond Age
of Emergency Medicine, Judith Tintinalli, MD, MS, FACEP, and Scott Weingart, MD, FACEP
10:30–11:30 a.m. Electronic Abstract Session V
11:30 a.m.–1 p.m. *EMF Showcase luncheon
1–2 p.m. Electronic Abstract Session VI
2–3 p.m. Oral Presentation IV—Little People, Big Results:
The Best of Pediatric Research
3–4 p.m. Prime Time Practice-Changers: Highlights of the 2015 Research Forum, Phillip Levy, MD, FACEP, Moderator, Chris Barton, MD, FACEP, and
Alex Limkakeng, MD, FACEP
4–5 p.m. Wine and Cheese Network Social
*By invitation only
Clockwise from top: Annals of Emergency Medicine training session in the ACEP Resource Center; an ambulance interior at innovatED; one of the many hands-on demonstra-tions at the Exhibit Hall; the Exhibit Hall from above; and David Lebell, MD, FACEP, at one of Monday’s procedure labs.
DON’T MISS THE LAST DAY OF THE RESEARCH FORUM
THE RESEARCH FORUM HAS BEEN ELEVATED TO NEW HEIGHTS IN 2015 WITH AN ELECTRONIC SHOWCASE AND MORE ORIGINAL RESEARCH THAN EVER BEFORE. Held Monday and Tuesday, Oct. 26–27, this is the world’s largest gathering of emergency medicine researchers, and access is free as part of your ACEP15 four-day registration. Listen to oral presentations followed by a discussion led by a recognized researcher. You can also view selected abstracts electronically, grouped by topic and critiqued by a recognized discussant.
WWW.ACEP.ORG/ACEP15
10 TUESDAY ISSUE OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS
ACEP POLL SHOWS INSURANCE INDUSTRY DRIVES PATIENTS TO SACRIFICE NECESSARY MEDICAL CARE
S even in 10 emergency physicians responding to a new poll are seeing patients with health insurance who
have delayed seeking medical care because of high out-of-pocket expenses, high deduct-ibles, or high coinsurance. The poll focuses on how the cost-cutting practices of health insurance companies are affecting emergen-cy patients and medical providers.
Nearly three-quarters (73 percent) re-ported seeing increased numbers of pa-tients because health plans are failing to provide adequate numbers of primary care physicians (“narrow networks”). The nar-row network trend is growing among health plans that want to hold down costs and dis-courage patients from seeking medical care. About two-thirds (67 percent) of the doctors reported that primary care physicians are sending patients to emergency departments to receive medical tests or procedures when health insurance companies refuse to cover them in an office setting.
“This is a scary environment for pa-tients,” said Jay Kaplan, MD, FACEP, presi-dent of ACEP. “Many patients are motivated by fear of costs and not by the seriousness of their medical conditions. The insurance companies are shifting costs onto patients and medical providers as they attempt to in-crease their bottom lines, and this threatens the foundation of our nation’s medical care
system. They call it cost-cutting when in re-ality it is profit-boosting. In addition, health insurance companies are shrinking the num-ber of doctors available in their networks, making it more likely that patients will be forced into out-of-network situations.”
According to the poll of 1,433 emergency physicians conducted by the ACEP in Sep-tember 2015:
• 60 percent of physicians reported hav-ing difficulty finding specialists for their patients because of narrow network plans that limit the number of medical providers.
• More than 80 percent reported treating patients who said they had difficulty finding specialists to care for them be-cause health plans have narrow net-works.
• 65 percent said they are seeing an in-creased number of patients in the emer-gency department, in large part because health insurance companies are failing to provide an adequate number of pri-mary care physicians to support the needs of communities.
• 73 percent reported seeing increased numbers of Medicaid patients because insurance companies were failing to provide adequate numbers of primary care or specialty physicians for their patients.
• 20 percent reported considering for themselves or knowing other emergen-cy physicians who were opting out of health insurance networks, with near-ly 90 percent of them saying the reason was because health plans were not will-ing to negotiate reasonable market rates for services.
“Insurance industry claims about ‘sur-prise bills’ are disingenuous since they created the ‘heads I win, tails you lose’ en-vironment,” said Dr. Kaplan. “Balance bill-ing would not even exist if health plans paid what is known as ‘usual and customary’ payment in the insurance industry—what is also known as ‘fair payment.’ Emergency patients are especially vulnerable because health plans know that emergency depart-ments never turn anyone away. Health in-surers have been taking gross advantage of patients and medical providers since the Af-fordable Care Act (ACA) took effect, arbitrar-ily slashing reimbursements to physicians by as much as 70 percent. Patients and phy-sicians should band together to fight these dangerous insurance industry practices.”
Dr. Kaplan also questioned why four of the largest insurance companies had the resources to merge, given the ACA requires insurers to spend at least 80 percent of pre-mium revenue on medical care.
“Isn’t the goal of the ‘Affordable Care Act’ to make health care more affordable?” asked Dr. Kaplan.
“Health insurers have been taking gross advan-
tage of patients and medical providers since the Affordable Care Act
(ACA) took effect, arbitrarily slashing reimbursements to
physicians by as much as 70 percent. Patients and physicians should band together to fight these dangerous insur-
ance industry practices.” —Jay Kaplan, MD, FACEP
Live from ACEP15
WWW.ACEP.ORG/ACEP15
OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS TUESDAY ISSUE 11
Q: WHAT ABOUT LEARNING AT ACEP15 IS DIFFERENT THAN LEARNING IN THE HOSPITAL OR AT HOME? “This is a little bit more rapid fire. You get to spend a couple of days and get rapid succession hours of high-yield information pretty quickly. That’s a better way to learn. It’s a much more fun way to learn. It’s intense, to the point. And I think a lot of ER docs like that.”
—Sommer Gripper, MD, MS, Montefiore Medical Center,
Bronx, New York
WWW.ACEP.ORG/ACEP15
12 TUESDAY ISSUE OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS
T his year’s 373-member Council rep-resents all 53 chapters, 33 ACEP sec-tions of membership, the Emergency
Medicine Residents’ Association (EMRA), the Association of Academic Chairs in Emergen-cy Medicine, the Council of Emergency Medi-cine Residency Directors, and the Society of Academic Emergency Medicine.
The resolutions adopted by the Council do not become College policy until they are reviewed and approved by the ACEP Board of Directors on Thursday.
On Sunday, the Council approved a reso-lution to increase the number of Councilors representing EMRA from the current four to eight seats. It was pointed out that EMRA was given its four Council seats in 1992 when it had about 2,500 members. Currently, EMRA has about 6,500 residents in its membership, in addition to several thousand medical stu-dents and alumni members.
The Council also adopted a resolution to address ethical violations by non-ACEP mem-bers. In an effort to address unethical expert witness testimony, this resolution will allow ACEP to admonish non-members and report the admonishment to the expert’s professional society, medical organizations, and state medi-cal licensing board.
The Council also adopted resolutions related to:
• ACEP and the pharmaceutical industry• American Board of Medical Specialties
Maintenance of Certification and Main-tenance of Licensure
• Critical communications for ED radiology findings
• Defining urgent care centers and trans-parency in urgent care centers
• Electronic nicotine delivery systems• Electronic submission of resolution
amendments• Emergency department detox guidelines• Enabling access to epinephrine for ana-
phylaxis• Establishing state and national physician
orders for life-sustaining treatment/end-of-life registries
• Fellowship status• Graduate medical education funding
• Group purchasing effects on patient care• Health care information exchanges• Increasing use of advance directives• Integrating emergency care into the
greater health care system• Intravenous ketamine for pain manage-
ment in the ED• Patient satisfaction scores and safe
prescribing• Procedural credentialing requirements• Prolonged emergency department
boarding• Reimbursement for ultrasound per-
formed by emergency physicians• Required CME burden• Searchable Council resolution database• Support for drug “take-back” programs
ACEP Council Considers Adding Members, Clinical Issues, and MoreThe 2015 ACEP Council considered several resolutions during its annual meeting this week, including issues related to public policy, clinical issues, and emergency medicine practice trends.
Returning College LeadersLeft to right: Vidor Friedman, MD, FACEP, and William Jaquis, MD, FACEP, were re-elected by the Council. James M. Cusick, MD, FACEP, was named Council Speaker.
• Telemedicine appropriate support and controls
• Transitioning out of medical practiceThese items were referred to Board for
additional consideration:• ER is for emergencies (best practices
campaign)• Patient satisfaction surveys in emergen-
cy medicine• Standards for fair payment of emergency
physicians• State medical board review of emergen-
cy medicine practice• Use of body cameras worn by law en-
forcement in the emergency departmentNext year’s Council meeting will take place
Oct. 13–14 in Las Vegas.
Council Elects New College LeadersThe ACEP Council selected two new ACEP Board members at its meeting on Sunday. Christopher S. Kang, MD, FACEP, FAWM (left), and Mark Rosenberg, DO, MBA, FACEP (center). Col. (ret.) John McManus, MD, MBA, MCR, FACEP (right), was elected as Council Vice Speaker.
Q: WHAT ABOUT LEARNING AT ACEP15 IS DIFFERENT THAN LEARNING IN THE HOSPITAL OR AT HOME? “I want to learn more to be more specialized. We have a lot of nice attendings, but they have their own point of view. I want to learn more from multiple perspec-tives. I’m from Japan originally…when you go to a Japanese conference, it’s just Japanese people. [This is] the best conference to see people from all over the world.” —Yoshito Okumura, MD, North
Shore University Hospital, Manhasset, New York
SATELLITE SYMPOSIA OFFER EVEN MORE EDUCATION OPTIONSINDUSTRY-SPONSORED SATELLITE SYMPOSIA PROGRAMS ARE EDUCATIONAL, AND SOME OFFER
CME CREDIT. THESE PROGRAMS ARE NOT A PART OF THE OFFICIAL ACEP15 EDUCATION PROGRAM AS PLANNED BY ACEP’S EDUCATIONAL MEETINGS COMMITTEE.
TUESDAY, OCT. 27, 6–9 P.M.
Caring for Critically Ill and Injured Patients in the Emergency DepartmentThe Westin Copley Place, Essex South Ballroom, Grantor: Janssen Pharmaceuticals
WEDNESDAY, OCT. 28, 6–8 A.M.
Stroke Prevention in NVAF: Optimizing the Use of Oral Anticoagulants in the Emergency Department
Grantor: Daiichi Sankyo
WWW.ACEP.ORG/ACEP15
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HISTORY
African Meeting House 46 Joy St.
Boston Tea Party Ships and Museum306 Congress St.
Freedom Trail139 Tremont St.
John F. Kennedy Presidential Library & MuseumColumbia Point
Old North Church193 Salem St.
USS Constitution MuseumBuilding 22, Charlestown Navy Yard
DINE IN STYLE
Algiers Coffee House40 Brattle St.
Chart House*60 Long Wharf
Legal Sea Foods255 State St.
The Oceanaire Seafood Room*40 Court St.
Palm Restaurant*1 International Pl.
Post 390*406 Stuart St.
Strega Waterfront*1 Marina Park Dr.
NIGHTLIFE
Cask ‘n Flagon*62 Brookline Ave.
Frost Ice Loft200 State St.
House of Blues*15 Lansdowne St.
ICON & VENU*100 Warrenton St.
Jillian’s/Lucky Strike*145 Ipswich St.
Laugh Boston Comedy Club425 Summer St.
The Living Room101 Atlantic Ave
ART AND CULTURE
Harvard SquareBrattle St. and Massachusetts Ave.
Harvard Museum Natural History 26 Oxford St.
Institute of Contemporary Art100 Northern Ave.
Isabella Stewart Gardner Museum*25 Evans Way
Museum of Science1 Science Park
Museum of Fine Arts, Boston465 Huntington Ave.
FAMILY FUN
Boston Children’s Museum308 Congress St.
Boston Harbor Islands National Park66 Long Wharf(ferry location)
Fenway Park4 Yawkey Way
Franklin Park Zoo 1 Franklin Park Rd.
LEGOLAND Discovery Center598 Assembly Row
New England Aquarium*1 Central Wharf
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Come Join Us for EDPMA’s Solutions Summit.
www.edpma.org
Emergency Department Practice Management Association
USE THE ACEP15
MOBILE APPMaximize
your experience!It’s available in the
Apple App Store and the Google Play store.
Get schedules, syllabi, and surveys. Use your login credentials from your ACEP15 registration.
WWW.ACEP.ORG/ACEP15
14 TUESDAY ISSUE OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS
Hot SessionsGetting a Better Handle on Atrial Fibrillation Treatmentby VANESSA CACERES
A trial fibrillation is the number-one sustained cardiac arrhythmia—do you know how to properly treat
someone with this condition? You will if you attend Tuesday’s ses-sion “Atrial Fibrillation Update 2015: Don’t Miss a Beat,” given by Corey M. Slovis, MD, FACEP, professor and chairman of the department of emergency medicine at Vanderbilt University Medical Center in Nashville. Dr. Slovis plans to discuss the non-acute risks that atrial fibrillation patients have—namely, stroke—and how they tie into the need for anticoagulation therapy. His session will focus on the CHA2DS2VASC score, which is a simplified scoring system to assess if a patient with atrial fibrillation requires anticoagulation therapy when leav-ing the ED. The scoring system includes factors such as heart failure, age, and hypertension history. Dr. Slovis’ session will address con-trolling rate versus controlling rhythm. He will also talk about trying to convert atrial fibrillation patients with a calcium channel blocker versus a beta blocker. Cardioversion and recommendations for pad placement also will be discussed.
Another part of the session will focus on anticoagulation therapy. Many emergency physicians are familiar with Coumadin (warfarin), but there are now medications called novel oral anticoagu-lants, or NOACs, that don’t require regular blood testing and involve taking just one or two pills a day. “It’s our job to work with the patient’s primary care physician to start these in the emergency department,” Dr. Slovis said. “It turns out if you start these in the emergency department, patients stay on them. If you wait to refer to the primary care physician, it can take six to nine months until they are treated, and they are at risk for stroke in the meantime.” VANESSA CACERES is a freelance medical writer based in Florida.
Acting Quickly to Treat a Critically Ill Infantby VANESSA CACERES
T reating a critically ill infant can be terrifying for an emergency physi-cian, said Richard M. Cantor, MD,
FACEP, professor of emergency medicine and pediatrics and director of the pedi-atric emergency department at Upstate Medical University, State University of New York, in Syracuse. “They don’t give you many clues, and they can’t give you any history. They don’t have a lot of measurable behavior to ask parents about,” Dr. Cantor said. In Dr. Cantor’s session, “The First 30 Minutes: Initial Management of the Critically Ill Infant,” he will aim to provide some help to physicians. “The session is essentially a how-to manual to give someone, in the midst of their panic, an organized approach,” he said. One point he will cover is the importance of listening to parents. “Even younger or uninformed parents know when something is wrong with their baby,” he said. Another point to consider with criti-cally ill infants is that they do not have any physiologic reserves when they become ill. “They don’t fight infection well, they become dehydrated quickly, and if they are born with a congenital problem such as a malformation, this is when it’ll show its true colors,” Dr. Cantor said. For example, vomiting in the young infant may be something benign or may be the result of a malformation in the gastrointestinal track. Or a cough could be secondary to an airway malformation. This gives the emergency physician a little more to think about when making a diagnosis. “What’s frustrating as the clinician is that you can’t fix the problem at the bedside. You have to get help immedi-ately,” he said. The good news, however, is that once infants get the appropriate care and stabilization, they often will stabilize, Dr. Cantor said. Fortunately, most congenital defects that are truly life-threatening will usually show up in the first two weeks after birth. Dr. Cantor’s session also will discuss diagnosis and treatment of shock, infections, cyanosis, heart disease, and seizures.
VANESSA CACERES is a freelance medical writer based in Florida.
Dr. Slovis
ATRIAL FIBRILLATION UPDATE 2015: DON’T MISS A BEATTuesday, Oct. 279:30–9:55 a.m.Room 153 ABC
Dr. Cantor
THE FIRST 30 MINUTES: INITIAL MANAGEMENT OF THE CRITICALLY ILL INFANTTuesday, Oct. 2710–10:25 a.m.Room 153 ABC
Eyeing Better Diagnosis and Treatment for Ophthalmologic Emergenciesby VANESSA CACERES
E mergency physicians must be com-fortable evaluating and treating a wide range of ophthalmology-relat-
ed emergencies, said Jason R. Knight, MD, FACEP, vice chair of ED operations and medical director of the emergency medicine residency program at Maricopa Medical Center in Phoenix. In Dr. Knight’s Tuesday session, “Essential Ophthalmologic Procedures and Examinations,” attendees will review ophthalmology fundamentals that often present to the emergency department. “It’s a good session to attend and review an entire semester of ophthalmology com-pressed down into a rapid-fire, 50-minute interactive lecture,” Dr. Knight said. One reason that ophthalmologic knowledge is so important for emergency physicians is because ophthalmology tends to be a Monday through Friday, 8 a.m. to 4 p.m., specialty, and a number of practices don’t even accept after-hours calls, Dr. Knight said. When treating patients, the emergency physician often must determine if an ophthalmic emergen-cy exists and whether a specialist needs to come into the ED, if patients can follow up the next day, or if they can follow up on a nonemergent basis as an outpatient.
Missing critical eye findings in patients can have devastating consequences, such as strokes, Dr. Knight said. Dr. Knight’s presentation will also cover use of the slit lamp, foreign-body removal, strokes, PanOptic ophthalmo-scopes, Tono-Pen, visual field testing, retrobulbar hematomas, ocular ultrasound, fluoresceins, Seidel testing, fundoscopic examination, and eye medications.
VANESSA CACERES is a freelance medical writer based in Florida.
Dr. Knight
ESSENTIAL OPHTHALMOLOGIC PROCEDURES AND EXAMINATIONSTuesday, Oct. 278–8:50 a.m.Room 210 ABC
Overcome Myths in Trauma Careby RICHARD QUINN
W illiam Mallon, MD, DTMH, FACEP, spent some 25 years at a Level 1 trauma center in
Los Angeles—and that means he’s seen a lot of people do things for, well, no good reason. That inspired his session at ACEP’s annual meeting: “Trauma Tea Party: Debunking Trauma Myths.” “There are a variety of myths that have just been propagated by the way trauma systems have been organized since their origins in the ’70s,” said Dr. Mallon, who starts in November as director of the division of international emergency medi-cine at Stony Brook University in Stony Brook, New York.
Dr. Mallon will urge emergency physi-cians to identify the best practices in trau-ma assessment and management and not just use techniques or ideas that are out-dated. That’s easier said than done, how-ever, when physicians are accustomed to, for example, a certain approach for airway management or the role of medication in rapid sequence intubation or the right chest tube to use in a given situation. “‘That’s the way we’ve always done it!’ is really not an easy boulder to move,” Dr. Mallon said. “You need leverage to move that. Sometimes you need the pry bar and leverage of evidence-based management. Sometimes you need the pry bar and leverage of health care eco-nomics. Sometimes you need the pry bar of more collegial, combined approaches. Sometimes you need the pry bar of another specialty looking in. There are a bunch of different tools. But no matter which tools you use … it’s never an easy rock to move.”
RICHARD QUINN is a freelance writer in New Jersey.
Dr. Mallon
TRAUMA TEA PARTY: DEBUNKING TRAUMA MYTHS Tuesday, Oct. 2710–10:50 a.m.Room 104 ABC
“It’s a good session to attend and review an entire semester of oph-thalmology compressed down into a rapid-fire, 50-minute interactive lecture.”—Dr. Knight
Dr. Slovis plans to discuss the nonacute risks that atrial fibrillation patients have—namely, stroke—and how they tie into the need for anticoagulation therapy.
“‘That’s the way we’ve always done it!’ is really not an easy boulder to move. You need leverage to move that. Sometimes you need the pry bar and leverage of evidence-based management.”—Dr. Mallon
WWW.ACEP.ORG/ACEP15
OCTOBER 26-29, 2015 • BOSTON, MASSACHUSETTS TUESDAY ISSUE 15
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Whetting Your “App”etite by KELLY APRIL TYRRELL
E sther Choo, MD, MPH, an emer-gency medicine physician at Rhode Island Hospital and assistant pro-
fessor in the department of emergency medicine at The Warren Alpert Medical School of Brown University in Providence, considers herself a digital health person. “I believe technology can help us be more efficient and deliver better care, safer care, and improve our patients’ lives.” But she doesn’t consider herself a techie. The challenges to integrating new tech-nologies, she said, are just overcome by the benefits. As an intern, her coat pockets were bursting with reference books and cards, an eye chart, a penlight, and other tools. She estimates she was hauling around an extra five to 10 pounds. Today, she has replaced all of these with her smartphone. In her Tuesday session, “‘There’s an App for That’: Handheld Devices and Applications That You Should Know About,” Dr. Choo will review technology that is changing the way physicians prac-tice, from single and multipurpose apps to an on-demand comprehensive drug data-base to a handy digital device. From the beginner to the experienced app user, Dr. Choo intends to offer a little bit for everybody, reviewing 10 low-cost
Dr. Choo
“THERE’S AN APP FOR THAT”: HANDHELD DEVICES AND APPLICATIONS THAT YOU SHOULD KNOW ABOUTTuesday, Oct. 271:30–2:20 p.m.Room 253 ABC
apps and devices all physicians should know. It will be just enough to narrow down what’s out there and to whet the appetite, she said. “A lot has changed over the past 15 years. These innovations are the kinds of things that excite me, and I hope to share that with others.”
KELLY TYRRELL is a health, science, and health policy writer based in Madison, Wisconsin.
Keeping Up With Guidelines for NSTEMI and ACSby VANESSA CACERES
D o you know the latest recom-mendations for non-ST segment elevation myocardial infarction
(NSTEMI) and unstable angina?
Dr. Hedayati
THERAPY FOR NON-ST ELEVATION ACUTE CORONARY SYNDROMES: UPDATE 2015Tuesday, Oct. 274:30–4:55 p.m.Room 210 ABC
With new therapies or guidelines every year, it can be hard to keep up, said Tarlan Hedayati, MD, FACEP, assis-tant professor of emergency medicine at Rush Medical College and associate program director in the department of emergency medicine at John H. Stroger, Jr. Hospital of Cook County in Chicago. In the Tuesday session “Therapy for Non-ST Elevation Acute Coronary Syndromes: Update 2015,” Dr. Hedayati will review the most recent literature on risk stratification and treatment of NSTEMI. One area that Dr. Hedayati will focus on is the latest non-ST elevation acute coronary syndrome (ACS) guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) and from their European counter-part, the European Society of Cardiology. She will detail some of the differences between the two guidelines. One recent update in the ACC/AHA guidelines is a change in the title of their guideline from NSTEMI to non-ST elevation ACS to reflect the spectrum of disease that ACS encompasses, Dr. Hedayati said. However, she likes to remind attendees that the guidelines are, well, guidelines and not the law.
Dr. Hedayati’s talk will also address the designated time limit of 10 minutes by which chest pain and suspected ACS patients should get an ECG. “When a patient walks through the ER doors, you don’t know if you’re dealing with GERD or a STEMI. Err on the side of caution,” she advised. The session will discuss how often physicians should repeat an ECG and troponin in the ED. Other areas that Dr. Hedayati will address include the use of troponin tests, risk stratification and prognostic scores, and various therapeutics available for patients having ACS and NSTEMI. “We will dig into what must absolutely be given in the ER, what can be given after admis-sion, and the evidence supporting the decision making,” she said.
VANESSA CACERES is a freelance medical writer based in Florida.
The session will discuss how often physicians should repeat an ECG and troponin in the ED.
TH-9504 Global branding campaign/TH reception ad size: 10.875 x 15 full bleed pub: 2015 ACEP DAILY (Tuesday, 10/27)
As facility medical director, Dr. Karen Kriza relies on TeamHealth to manage the administrative duties
associated with operating an efficient emergency room. Thanks to TeamHealth’s support with scheduling,
recruiting, insurance negotiations and risk management, Dr. Kriza has more time to focus on her patients
and family and enjoy the luxuries of living by the water.
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Enjoy a big-time evening at a world-class museum in Boston!
Join TeamHealth for our Annual Physician Reception during ACEP 2015.
Explore the interactive exhibits at The Museum of Science, Boston—one of the
world’s largest science centers and New England’s most attended cultural
institution. Plus we’ll have delicious Boston cuisine, an open bar and dance floor. It’s the formula for fun!
Please visit our ACEP booth #609 to get your free ticket for this event!
Don’t Miss TeamHealth’s Physician ReceptionTuesday, October 27 7 pm Museum of Science, Boston
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